Demonstrate consideration and basic understanding of the essential values and philosophy of the sector in work undertaken
In all work, reflect basic knowledge of the current issues which impact on the sector and different models of work
Methods used by AOD workers
In collecting information about the alcohol and other drugs sector, collect and use the views of key stakeholders and representatives from relevant target groups
Apply understanding of risks related to personal safety when working in AOD sector
Occupational health and safety (OHS) aspects of providing care
We often hear in the media that a person or a group of people have had their basic human rights violated. While most of us have an idea what this means, we don’t often stop to consider what human rights actually are.
The range of human rights that everyone should receive is outlined in the United Nations Declaration of Human Rights. There are 30 Articles in the Declaration that highlight the basic rights of all people. A good website to view the rights is:
The Human Rights and Equal Opportunity Commission at: http://www.humanrights.gov.au/
The Declaration includes the rights to:
All too often people with AOD problems are denied some or all basic human rights. There is a social belief that exists as a result of their AOD problems—that they have lost their rights. The reasons why this can occur are very complex, but may include:
Some concepts that underpin rights in an Australian context include:
Clearly, all Australians are entitled to receive their basic human rights. As part of your practice, it is essential that you work in a way that protects the rights of your clients. There will be times that you will, no doubt, be required to speak out and advocate on behalf of your client/client groups who, for the very reasons we have discussed in this topic, may be unable to do it for themselves. They may be overwhelmed by the difficulties they face in trying to survive, let alone think about and assert their rights. Or, they could also be affected by issues such as race, gender, disability, health and age that act as a double bind when coupled with an AOD problem.
Another underpinning value and philosophy of the AOD sector is harm minimisation. This is an approach to AOD use that recognises:
This approach allows AOD workers to work from a framework where they can aim to:
For many workers being able to work with clients from this perspective can initially be very challenging. Workers have their own personal stories and experience that frame their beliefs about AOD use, and for some this can be the belief in the abstinence approach. So, to be asked to work from an approach that accepts drug use can be very challenging. Rumbold, Kellehear and Hamilton (1998)
Ultimately, it can also be a very liberating experience as there is no requirement to make judgements about use, the likelihood of relapse and so on, but to simply identify behaviours that are harmful and offer ways of minimising the risk of harm.
From an ideological point of view it fits neatly with principles such as Biestek’s and it is client centred. It asks the worker to see the world from the client’s perspective and work from there. Harm minimisation programs can be created to meet the needs of diverse communities and groups. For some workers there is a struggle in this approach, particularly when working with young people (eg concerns about asking young people to make decisions that they may not understand the long-term consequences of) and yet it is one approach that can work well with young people. It is not seen as an adult saying ‘no’, but rather accepting what is happening and asking young people to continue their activities in a safer way. The use of peer education (where young people are given information so that they can educate their peers) is also a popular harm minimisation strategy. Again, not using a professional or an adult to provide information, but a peer whose knowledge is often far more readily accepted.
It does not make the workload of the AOD worker lighter, just different. There is often a need to be creative, opportunistic and flexible. It also asks workers to examine their goals and expectations for clients and critically think about whose needs they are meeting in their intervention processes.
|Go to Essential knowledge and read the topic Confidentiality|
Throughout history people have tried to understand the phenomenon of drug use and why some people become dependent on or addicted to certain drugs. Many theories have been put forward and around some of these theories models have been developed. A model is a way of classifying or defining a problem or situation so that it can be understood and communicated to others. Think of a street with a number of houses in it. Each of the houses is different, one is a three bedroom brick veneer, another, a cedar cottage, another a four-bedroom Hardiplank and tile, another a one bedroom fibro cottage, another a two bedroom duplex—each of these houses is based on a model, designed to meet a need.
What follows is a description of the six models of drug use and dependency that have most influenced Australian drug policy and treatment of drug use behaviour. There is no ‘right’ model; it’s a little like our houses, they have developed over time and often as part of social processes happening at that particular point in history. As with a house, what suits one person may not suit another, therefore, it is important that we are able to provide a range of options and that we work closely with our clients to establish what service based on what model will best suit clients’ particular needs.
Historically this model has had an effect on how we have treated drug users since European settlement of Australia. Today we can still see its power in our legal system.
The basic belief underlying the moral model is that using drugs is morally wrong, deviant and antisocial.
These moral judgments change between cultures. For example, in Australia marijuana and hashish are illegal (except in Canberra for personal use) and under this model the users would be thought of as wrong. Here, alcohol is legal, used widely and often not even thought of as a drug. However, in some countries the possessions and use of marijuana and hashish is acceptable and not illegal. As well, alcohol may be unacceptable within some cultural and religious groups wherever they live, and illegal for citizens of some countries.
The moral model considers that drug dependent people are morally weak. Dependency, or addiction, is seen as a character fault. Drug users are viewed as victims of moral weakness who know that what they are doing is wrong but continue to do it.
People subscribing to the moral model believe that to prevent drug problems, society needs to:
Those subscribing to the moral model believe that users should receive the following treatment:
At the turn of the century many drug users were put in mental hospitals but this was only because the jails were full. They did not receive treatment (eg AA support counselling or post-treatment follow-up) as they would today.
The use of the term ‘drug habit’ was first used in Australia in 1887 and marked the beginning of the development of the concept of drug use as an ‘addiction’—something over which the user had no control. Originally it was used in the context of cocaine and morphine use. By the turn of the century alcohol had also been included. This led to the development of the Inebriate Acts of the early 20th century, which not only identified the ‘disease’ but also the treatment—incarceration as a form of treatment and not punishment, as had previously been the response and practice.
This definition, however, did little to change the actual position of those with the problem. Being a medical inmate, as opposed to a criminal inmate did not guarantee any change to power over destiny. In fact the definition of alcoholism as a disease still deprived the sufferer of all power and freedom. To call addiction an illness simply created a medical condition out of a behaviour that had previously been seen as immoral, criminal or simply harmless and became yet another means of social control.
The creation of this model led to the development of the Alcoholics Anonymous (AA) movement and, interestingly, was started by a doctor who also considered himself to be an alcoholic. His belief was that certain people were not morally weak but had a predisposition to becoming alcoholic. Alcoholism was a disease like diabetes and sufferers should be treated as though they had a disease. Although AA began in the 1930s in America, it did not have much impact in Australia until the 1950s. This is when the first hospital was opened strictly to treat alcoholism.
The disease model has had a profound effect on treatment facilities in Australia up until the present. Most rehabilitation and detoxification centres have followed the philosophy of AA, although in the 1980s the public health model started to become a stronger influence.
Other groups have developed along AA principles and the disease model philosophy. They are:
These groups are referred to as ‘self-help’ groups as they are free to join and run entirely by the people who attend them. They are still very popular in Australia and around the world.
As with other diseases, like diabetes, some people have a natural predisposition to addiction. Addiction is controlled by physiological and genetic forces beyond the person’s control.
The classic disease model of addiction rests on three major assumptions:
Identify people at risk and provide education about the dangers of beginning to use a particular drug.
Addicts need to acknowledge their addictions and the fact that they have no control over their substance use.
They need to remain abstinent from all mood-altering substances for the rest of their lives, otherwise their addictive behaviour could begin again. This means if you are an alcoholic, you cannot drink but neither can you use marijuana, even if you were not addicted to it before.
Addicts need to attend self-help groups like Alcoholics Anonymous for support.
Psychodynamic theory began with the work of Sigmund Freud, and its use in treating people with drug problems began in Australia with psychiatry in the 1950s. However, it does not have wide use in treatment as lengthy psychoanalysis is not considered cost-effective. Nonetheless, the basic philosophy, that what happens in our childhood can affect how we cope as adults, is accepted nowadays as an important principle in most treatment therapies.
Drug misuse is an unconscious response to difficulties experienced in an individual’s childhood. This philosophy historically provided the basis of most counselling approaches. It has been widely replaced by psychosocial theories in more recent times but can still be practised in private psychiatry.
People whose personalities/behaviour place them at risk of developing substance use problems should be identified. They then can be provided with drug education or intervention at an early stage in the course of their difficulties.
Psychodynamic counselling is used to gain insight into the person’s unconscious motivations and to improve their self-image.
This model is based on the cognitive behavioural theories in psychology and learning—beginning with the theories of B. E. Skinner. This theory initially gained acceptance in America in the 1950s, with the behavioural theories, and has been expanded to include cognitive (patterns of thinking) theories and in more recent times the exploration of links with the social environment (narrative and solution focused therapies).
Psychological theories started to influence thoughts on treatment when American soldiers returned from the Vietnam War. Many of these soldiers had been heavily addicted to opiates while fighting in the war. On their return, they gave away the use of these drugs and got on with their civilian life.
This put into question the disease model. That is the belief that, firstly, only certain people could become addicted and that the addiction was progressive unless you abstained totally from all mood-altering substances.
These soldiers represented a group of people who used and became physically addicted to a substance to cope while they were in horrific circumstances. Once they were out of these conditions many returned to their previous level of social drug use.
The basic philosophy of the psychosocial model is that dependence or drug abuse is an acquired habit. It is maintained by powerful pyschological and social forces in the person’s environment.
This model promotes the idea of drug education programs and media campaigns to increase appropriate decision making skills and promote healthy life styles.
The person can learn new coping mechanisms and social skills, and can adapt his or her beliefs and lifestyle to deal with the circumstances so as not to abuse drugs. Treatment under this model emphasises the importance of reinforcing the person’s ability to manage their own life.
Methods of treatment include:
This model was popular in the 1970s and up until the last 10 years has been the least used model. As you can see from the models already discussed, there is an emphasis on the individual with little examination of the type of society they may live in and what effect this may have on their drug use, this model takes into account the society as a whole.
With the Federal Government’s Drug Summit in 1985, attitudes began to change. What came out of that summit was an acceptance that certain groups in society were disadvantaged (this had already been acknowledged in the 70s). These groups had to take priority in prevention and treatment policies of the future. The national drug strategy 1992–97 targets certain groups in the community for assistance. We will discuss these later.
The basic philosophy of the socio-political model is that people who lack power in the world and are alienated are more likely to experience substance use problems.
Drug consumption patterns can be analysed in relation to the creation and maintenance of social inequality in our society.
Society labels the disadvantaged users of certain substances as deviants, thereby creating further problems.
Prevention strategies include:
Treatment of the individual may not be helpful or necessary. Powerless groups should be empowered by building support networks and enabling them to make decisions about their own lives.
This model began in 1955 but achieved greater acceptance in 1985. The National Drug Strategy 1992–97, based on this model, has guided all treatment and prevention programs in Australia over the last five years.
The public health model is an integrated approach. It identifies the three key factors and the interrelationship between them.
The basic premise of harm minimisation is acceptance that drug use is a reality within our society, and that trying to eradicate it is an unattainable goal. A more realistic goal is reducing the harm brought about by certain types of drug use.
What is most important in the public health model are:
Treatment is seen as the final (or tertiary) stage of prevention. This is when a serious problem has developed and treatment is aimed at arresting the progress and restoring the person to health by all the means that are presently available.
Activity 1: Which model best fits your beliefs?
Every Friday afternoon a group of office workers go down to their local pub after work to celebrate the end of the week with a few drinks. By 8 pm they have had quite a few drinks and their departure from the pub is very noisy and disruptive to the surrounding residents and businesses.
The local community is up in arms, they feel that their businesses are affected by this chaos. They have spoken to the group and to the publican with no success in containing this situation.
They have now taken the problem to their local politician who is concerned about the effect it is having on the district and the residents.
The politician needs to choose a framework or model from which to approach the problem. She has chosen certain groups in the community to put forward their ideas to her on how to deal with the problem.
Activity 2: The great debate
Form a debate: community versus government body.
Imagine that you are a member of the community representing one of the models. Put forward an argument from the point of view of this model on how this situation should be dealt with. For example, moral model—these people (the drinkers) should be punished and the police should be brought into to control the situation. Remember, you are not arguing your own view but that of a particular model and you really want to convince the politician that this is the best model. Sometime it is fun and sharpens your negotiating skills to argue from the point of view of a model you do not agree with. So give that a go.
Argument for the community: Now you give an argument from the point of view of the public health model
This activity illustrates what goes on in the real world when it comes to deciding what to do about drug problems. Different groups in the community will try to influence politicians on how they consider the problems should be dealt with. There is nothing wrong with this and it is part of the normal political process in a democracy.
In recent times the public health model has been predominate. Society is very concerned about young people using drugs and you may have seen the major media campaigns. It is important that you start developing an understanding of the public health model and how it addresses AOD issues.
This section of the topic will explore the different methods that are used by workers in the AOD sector. They include:
We will look at each of these in some detail.
Casework involves working on a one to one basis with a client. At one end of the continuum casework can be very informal, a simple one-off session together, where a client speaks with the worker, raises some issues and the worker provides the client with some information and knowledge. That is the end of their contact. The worker may keep a few brief notes about the exchange, perhaps a name, date and a brief outline of issues discussed and decisions made, including information and possible referrals provided.
This is called informal and unstructured casework. Some examples may include information and referral services and drop in centres.
At the other end of our casework continuum we will have workers who provide a highly structured and formalised approach, that often involves detailed record keeping.
The most commonly used example of a structured and formal type of casework in the AOD sector today is case management.
Case management is a concept that developed during the 1970s in the USA and 1980’s in Great Britain. It was first used in the aged care and disability sectors—areas where clients may have quite complex needs—that require a range of services. Its purpose is to find a better fit between clients and services. The worker, who is usually referred to as the case worker or case manager is responsible for:
It involves a number of key tasks including:
The tools that are required to ensure that case management is effective include:
Many government departments use a case management approach to work, including Probation and Parole, Department of Community Services, Corrective Services, Drug and Alcohol Services and increasingly this approach is also being adopted by non-government organisations including therapeutic communities.
In order to be effective case workers and get the best possible outcomes for their clients workers need to:
This method involves a worker working with a group of clients. As with casework it can be a structured and formal process, that involves a set format that the group process will follow and includes the keeping of detailed records about who attended the group, their input, issues explored by the group, and outcomes achieved or it may be as simple as an informal discussion group or ‘get together’. In the AOD sector group work is used extensively as a method of working with clients.
Group work may occur as a one off meeting or get together, it may occur on a regular basis over a number of weeks or it may be an ongoing process that occurs for a number of years.
Group membership may be closed, that is, once the group forms no new members are taken into the group, or it may have an open membership, where members come and go and new members are welcome.
A group that is often the focus of intervention is the family. It is identified as a significant social institution in Australian society and a critical element in an individual’s psychosocial development, and is, therefore, often the target of intervention processes.
Both the current NSW Government Plan of Action and the National Drug Strategy recognise the importance of family, particularly in the prevention of drug related harm. Both these policies focus on providing support to families through strategies that aim to expand prevention and early intervention services to families (such as the Families First and Schools as Community Centres programs and raise family awareness of AOD issues, particularly in relation to young people). This approach seeks to provide support to families that may be seen to be at risk, particularly in rural, remote and other disadvantaged communities, and to also provide information and support that will strengthen families and their ability to deal with AOD issues.
Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Nar-Anon and Al-Ateen meetings—These groups provide an opportunity for people with AOD issues to get together and explore their problems and situations. AA and NA provide support to users themselves; and Nar-Anon, Al-Anon and
Al-teen provide support to family members and friends whose lives have been affected by those who use. Meetings are held on a regular basis and membership is open to those who have AOD issues. Although the group meetings have a structure and process, little record keeping occurs due to the philosophical commitment to confidentiality and privacy.
Groups that are run in therapeutic communities as part of the program—In these groups, clients of the service (members of the community) attend to explore a whole range of issues that can be linked to their AOD issues, recovery processes and personal development (eg self esteem, who am I? leisure activities, relaxation) or the management of the program (eg what’s happening in the house? work detail groups).
Groups that are run in detox centres as part of the program—Often these groups will focus on issues linked to the group members use, AOD issues and personal development. They will have a similar focus to those groups run in therapeutic communities. Often they will vary according to the philosophy of the individual service.
Outpatient services groups—Often outpatient facilities providing AOD services will require that clients attend groups as part of their program. These will often focus on relapse prevention and stress management.
Outreach groups—These may be groups that are provided by AOD services, particularly non-government organisations, that work in the community to provide support networks for clients with AOD issues who, for a range of reasons, don’t access mainstream AOD services. They will often use other non-government organisations to access clients.
An example of an outreach group: On the Central Coast of NSW a women’s AOD rehabilitation service, Kamira Farm, provides AOD outreach to women through local Women’s Health Service Centres.
AOD services offering groups—These groups may be provided as part of a service by either government or non-government services. The focus of the groups will often vary according to the client group of the service or a specific need that may have been identified by the local community, eg the Manly Drug and Alcohol Education Centre on Northern Beaches, Sydney, runs ‘Trimming the Grass’, a 4-week program for young people that looks at cannabis use.
Community work is a method whereby the AOD worker will work with a community, rather than with an individual or a group of clients. It relies on a collective approach to solve problems and make decisions about needs, goals, priorities and programs. An example may be when local residents in a community raise concerns about alcohol related vandalism in their community. The AOD worker might organise a meeting whereby the local residents, police, local government and other relevant parties get together to explore the issue and develop some strategies to respond to the problem.
The target community may be geographically defined (eg the Moree community, the Orange community, the Wyong Shire Local Government community) or it may be a community that is based upon a specific identification or need (eg the gay community or the drug injecting community).
There are three approaches within community work and community workers will often use all three approaches in their work. These are:
Community development is a form of community work where communities work together to identify and explore issues and problems that exist. As a result of this exploration, strategies are developed to deal with an issue or problem. Often this process of identifying and exploring problems may involve a number of people getting together. The people involved can include: representatives from the community services industry, local organisations, local businesses, local residents, local government and representatives from state and Federal government departments (depending on the nature of the issue and relevant stakeholders). Where there is involvement from a number of sectors it is an inter-sectoral approach to issues and problems.
Community development, using the inter-sectoral approach, is the method that underpins the current Community Drug Action Team concept. It recognises, as does all community work, that communities can essentially be quite different, particularly in relation to their ethnic or racial backgrounds, their age-related populations (some have higher numbers of younger or older people than others), their incomes and status, and access to resources, particularly if they are in rural or remote parts of Australia.
Therefore, communities will, as a result of their differences, need different strategies to help them deal with the problems and issues they face. Although, at times all communities experience similar social problems such as unemployment, poverty, AOD problems and domestic violence.
As part of community work it is recognised that any development that takes place, particularly if it involves public funding, needs to be planned. Often community workers will be involved in the development of a community plan that identifies the key issues and problems that face a community and the strategies that need to be put into place. Sometimes this planning role in a community is undertaken by local council, but may also involve local community services (both government and non-government), local businesses and residents.
As part of raising community awareness about issues, workers will often be involved in community action. These are strategies designed to capture attention and make demands of the larger community for increased resources to deal with issues and problems. It includes activities such as demonstrations, street marches, awareness days or awareness weeks. Examples include: Breast Cancer Awareness Week, Daffodil Day, World AIDS Day, Red Nose Day (Sudden Infant Death Syndrome) and Jeans For Genes Day. One of the most famous examples in Australian history of community action was the Tent Embassy, held on the lawn outside Parliament House in Canberra by Aboriginal people seeking to raise political and public awareness of their situation.
As well as these kinds of events occurring at a national or state level, they might also happen at a local level. In the AOD sector, community action strategies are being used by Community Drug Action Teams to raise community awareness about AOD issues. An example is the Goats Festival that was organised on the Central Coast of NSW to raise drug awareness amongst young people. The festival consisted of a number of events including music, sausage sizzles and information stalls at a local shopping centre.
Community education has long been recognised as a form of community work as it focuses on working with communities to help them address issues and problems, using education as the tool. Education has long been recognised as a means for bringing about change in people’s behaviours, beliefs and attitudes.
The aim of AOD education at a community level focuses on increasing knowledge, promoting positive and healthy attitudes and encouraging specific changes in behaviour related to the safer use of both licit and illicit drugs. Part of community education also focuses on identifying target groups that have particular issues and creating strategies to meet their needs. This may mean the strategies used to target young people and alcohol use may look different to a campaign that targets older alcohol consumers. Both campaigns are addressing the same issue (alcohol use) but use different strategies to meet the needs of different groups. A campaign to meet the needs of a predominately Italian community or Aboriginal community may look different again.
Community education may use the following broad strategies in creating AOD campaigns:
Health promotions play a significant role in providing AOD community education in Australia. Current health promotions philosophy is underpinned by the Ottawa Charter for Health Promotion, a policy that was created at the First International Conference on Health Promotion, held in Ottawa Canada in 1986.
It outlines health promotion as the process that enables people to increase control over, and improve, their health. To reach a state of complete physical, mental and social wellbeing an individual, group or community must be able to identify and realise aspirations, to satisfy needs and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.
The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity.
The Ottawa Charter also identified community education as one of the five methods of health promotion. Health Promotion Units form part of Area Health Services and use the strategies discussed above in ‘community education’ in order to meet their outcomes.
Research is a method which begins with people asking questions and then seeking to find answers. This is done by systematic collection of information and evidence from observation, which is then analysed and explained.
It is something that is done in our everyday lives—think about the process that you use if you are going to buy something. You decide what you want (based on your need) then you look at the options available (model, cost, availability, etc) and then you make a decision based on your ‘research’.
Guidelines for good research practice include:
Research is an important method used in the AOD sector. It is undertaken through health promotion programs to investigate problems and issues, and then to create programs to meet identified needs. It is also undertaken by health professionals as they establish problems, issues and strategies that can be used by their services to address issues. It is done by community workers as they develop community work strategies to deal with AOD issues, and it is also undertaken by those responsible for creating government policies, as they investigate problems and issues and then create policies to deal with identified issues and problems. An essential part of good policy and program development is the use of research.
Some examples of AOD current research include:
National Drug & Alcohol Research Centre (NDARC). The National Drug and Alcohol Research Centre (NDARC) was established at the University of New South Wales in May, 1986 and officially opened in November, 1987. It is funded by the Australian Government as part of the National Drug Strategy (formerly, the National Campaign Against Drug Abuse). http://ndarc.med.unsw.edu.au/
RADAR Register of Australian Drug and Alcohol Research. RADAR, a project of the Alcohol and other Drugs Council of Australia, aims to promote awareness of alcohol, tobacco and other drugs research in Australia. The register contains up-to-date records of current and recently completed research projects with details of published research. There is also information about researchers, their organisations and research funding bodies. http://www.radar.org.au/default.aspx
The National Drug Research Institute (NDRI) conducts and disseminates high quality research that contributes to the primary prevention of harmful drug use and the reduction of drug related harm in Australia. NDRI, which was formed in 1986, plays a key role in national harm prevention strategies through research designed to establish the preventive potential of legislative, economic, regulatory and educational interventions. NDRI is located at Curtin University of Technology's Health Research Campus in the western Perth suburb of Shenton Park and receives core funding from the Australian Government Department of Health and Ageing. http://www.ndri.curtin.edu.au/
National Drug Strategy: The National Drug Strategy (NDS) and its forerunner, the National Campaign Against Drug Abuse (NCADA), have been operating since 1985. Both NCADA and NDS were created with strong bipartisan political support and involve a cooperative venture between the Commonwealth and state/territory governments as well as the non-government sector. http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/research-lp
Dr. Marianne Jauncey is the Medical Director of the Sydney Medically Supervised Injecting Centre.
Here she talks about findings from the National Drug Strategy.
What do you think is the most harmful drug? Watch the video to find out
Australian Drug Information Network: Databases and research: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/research-lp
National Drug Law Enforcement Research Fund: The National Drug Law Enforcement Research Fund was established by the Ministerial Council on Drug Strategy (MCDS) on 10 June 1999 and commenced operations in August 1999. This Fund incorporates both the National Drug Crime Prevention Fund (NDCPF) and the National Community Based Approach to Drug Law Enforcement (NCBADLE). http://www.ndlerf.gov.au/about.php
Activity 3: Health promotions
It is important that we have knowledge of a range of not only alcohol and other drug services that are available in our community, but a range of other services that our clients may be able to benefit from. One of the most important skills that an alcohol and other drug worker needs to have is the skill of knowing not only what service is provided by the organisation they work for, but what other services are available to meet the needs of their clients—at a local level and regionally. Many communities have limited access to appropriate services and often clients need to be referred to services and organisations beyond the local area. Often this knowledge is contained in local Community Service Directories that are usually available through local councils. Workers also develop their own directories that include information relating to the name of organisation, the service it provides, address and contact details.
The worker also needs to be able to develop good working relationships with these services, often gained through networking. This can occur on a casual basis, telephone conversations and informal meetings, or may occur on a more formal basis through local networking meetings—Interagencies or Forums. It is an important part of your learning to become aware of the networks that exist in your community and, where appropriate, to become involved.
There are lots of agencies providing services to people in our communities. Strategies that you can use to find out about agencies in your local community as well as regional, state and federal agencies include:
A worker will need to be able to identify the relevant stakeholders in an individual client’s situation, as well as the stakeholders that may be involved in alcohol and other drug issues in the broader community.
A stakeholder may be defined as either an individual or an organisation that has a vested interest in a situation. You will learn the skills of recognising and negotiating with stakeholders later in your studies—it is important, however, at this stage in your learning you are able to recognise the term and be aware that in any situation, or with any social issue, there will be stakeholders involved, often with a wide range of vested interests.
They may include:
Rogers Kumar is a clinician working at the Sydney Medically Supervised Injecting Centre.
Here he talks about security while working in the AOD industry.
When you chose to try and calm the client the interaction should be simple, direct and brief.
If all the above techniques fail move on to the next step:
Call for assistance
In Part 2, Division 3 of the NSW OHS Act 2000, it is stated that:
All persons must not:
Disrupt a workplace by creating health or safety fears.
The OHS Act protects psychological welfare as well as physical safety. It is the responsibility of employers to ensure that personal threats of any kind are not allowed in the workplace.
Violence includes verbal and emotional threats, physical attack to an individual’s person or property by another individual or group. The level of fear an individual feels and the way they respond during and after a violent act relates to their own experiences, skills and personality. Violent acts include:
Violent behaviour can escalate from intimidating body language, to verbal threats and physical violence.
Staff need training in how to recognise the possibility of violence occurring and how to respond in the event of verbal and physical attack. All workplace procedures should be geared towards preventing this occurring in the first place.
WorkCover Guide 2000 Violence in the Workplace offers these practical suggestions for controlling violence risks:
Staff training programs should cover specific violence control in your workplace. In consultation with employees, a Workplace Violence Prevention Policy should be developed and implemented.
Rogers Kumar is a clinician working at the Sydney Medically Supervised Injecting Centre.
Here Rogers talks about how he copes with working in aggressive situations.
AOD agencies, by law, are required to have in place sound OHS policies and procedures to protect the health and safety of clients and staff. OHS is the means whereby an organisation tries to prevent injuries and illnesses and maintain a healthy and safe environment through putting together, maintaining and promoting an OHS structure in the workplace.
Let’s look at some of the major reasons that an AOD agency would have OHS policies and procedures:
When working with intoxicated clients there are many things to consider in terms of OHS in the work environment. It is important that the space that the client comes into, whether it is a community health centre or an outreach bus, does not pose any physical or other risks for the client’s safety. It is also important that staff who work with intoxicated clients have a safe working environment that allows them to carry out their duties without the risk of injury—be it a physical or psychological injury.
How safe is the workplace in terms of the potential for accidents to occur? The workplace might be an outreach bus, an office or doing street work. Intoxicated clients may be more likely to have accidents due to being intoxicated. Are there ways of making the workplace safer for the client?
How secure and safe is the workplace that you are working in?
Working with clients who are intoxicated poses a potential risk of clients being verbally or physically aggressive. Staff who work with intoxicated clients need to have undertaken aggression management training. Safety when working with intoxicated clients includes never working alone.
The AOD agency needs to have a First Aid policy and a way of being able to manage and prevent injuries from occurring. There should be very clear policies with regard to working with an intoxicated client who has sustained a physical injury. The AOD worker must not put themself in a situation that requires a more specialised intervention. An example of this might be monitoring an intoxicated client who fell over and lost consciousness briefly. This client needs to be assessed by a hospital Emergency Department. The role of the AOD worker is to contact 000 and have the client transferred to a nearby Emergency Department.
There are many OHS health issues such as being able to work in a smoke free environment or a workplace that is not too noisy. It is also important that staff and clients are not at risk of contracting communicable diseases such as Hepatitis A and Hepatitis B.
Rebecca is a regular client who drops in to the agency to see an AOD counsellor. She is well known to most of the staff and has a history of abusing alcohol and benzodiazepines.
Today, Rebecca comes into the agency, staggers over to the receptionist and very loudly demands to see someone immediately. She is told that she will have to be patient and wait as all the counsellors are busy. There are other clients in the waiting room. Over the next ten minutes Rebecca becomes increasingly more agitated and takes several pills out of her bag and swallows them, telling the receptionist that they will help her to calm down.
Rebecca, in the previous activity, posed a risk to staff, other clients and herself. The care that this intoxicated client would require would include an assessment of her level of intoxication and that there be a safe environment for all workers and clients.
Consider the following story.
Peter and Sally are working on the outreach bus that goes around the local area picking up intoxicated youth, assessing them and placing them in a safe house or contacting parents/caregivers to pick them up. It is late on Friday night and the bus has pulled up to a park where there is a lot of under-age drinking and other drug use happening. Peter and Sally, who know many of the young people at the park, come across three girls who appear to be having really bad ‘trips’.
The girls appear to be hallucinating and have been throwing up. Two of the girls have vomit on their clothes. One of the girls has fallen over and hit her head and she has blood on her face and arm. The workers can’t seem to get much information from the girls and don’t know if there are other drugs that have been used. The girls agree to come onto the bus.